Mental Illness and Public Safety
Beat Intro
Voiceover
00:00 This is the Beat—a podcast series that keeps you in the know about the latest community policing topics facing our nation.
Interview
Vonda Matthews
00:08 Hello and welcome. My name is Vonda Matthews. On behalf of the COPS Office I would like to thank you for joining us for the fourth in a series of five podcasts on the issues surrounding school safety, the role of police in schools, and the importance of community coordination in the identification and referral of children who have been victims of or witnesses to violence, as well as children with emotional or behavioral health needs. Joining us today are Ron Honberg, the National Director of Policy and Legal Affairs at the National Alliance on Mental Illness (NAMI), and Darcy Gruttadaro, Director of Child & Adolescent Action Center at the National Alliance on Mental Illness.
Thank you both for taking time to join us for this important discussion on the early identification and the resources available for persons suffering from mental illness. Ron, I want to first ask you, the National Alliance on Mental Illness is the nation’s largest grassroots mental health organization. I know you’re dedicated to building better lives for millions of Americans affected by mental illness, and you advocate for access to service, treatment, support, and research. What do you believe are the greatest obstacles to building a community of hope?
Ron
01:17 Good morning Vonda. Thank you for having Darcy and I on the call. I guess to first start by clarifying the term community of hope. Our goal at NAMI is to help create a society that is more understanding of mental illness—that better understands what these illnesses are—and a society that responds compassionately to people who are, you know, showing or manifesting the symptoms of mental illness, rather than running away from people or shunning people, which is today still too often the case. You know, the biggest obstacles to building a community of hope, there are a number of those, but you know certainly first would be continuing negative stereotypes—some would refer to it as stigma—towards mental illness. And it’s really very notable or noteworthy that we respond so differently to people with mental illnesses than we do to people with physical illnesses. If someone has a physical crisis—clutches their heart, their chest—we rally around them, we try to help them. If somebody behaves in erratic way that might be indicative of a possible mental illness, again, we tend to run away and shun them. So lack of public awareness, a lack of knowledge about how to help someone in crisis, and that even extends to our schools and to our families. Those are obstacles and challenges for us to overcome. Certainly I can’t underestimate or discount the negative impact that massive budget cuts in mental health services have had across the country in recent years. We’ve cut more than $4 billion from our public mental health systems. We’ve eliminated more than four thousand inpatient psychiatric beds and many community programs, as well. So, frequently people don’t have access to services, continuous services, and these are, after all, chronic conditions like diabetes and epilepsy. So treatment—effective treatment—effective services and supports exist, and there’s all sorts of evidence that if people receive them they can recover and live productive, meaningful lives, but most people don’t receive those in this country. And then finally when we do fund services, you know we still too often fund services that don’t work, and we don’t fund services that do work, and that’s a challenge that we all face in the mental health community.
Vonda
03:35 The next question is: there’s a renewed interest in sharing information between law enforcement, schools, and mental health service providers about individuals that may suffer from a type of mental illness that may pose public safety threats. We know that a person who suffers from a mental illness is more likely to be a victim of crime rather than a perpetrator. How can sharing of information be in the interest of the person suffering from an illness or in the interest of their families?
Ron
03:58 Really in a number of ways. In particularly, you know, thinking about this from the perspective of a law enforcement officer, it’s no secret our law enforcement officers have become first-line responders to people in crisis. They’ve become an integral part of the mental health system, even though that’s not what they’re trained, or they necessarily thought they’d be doing when they entered police academies. But they frequently encounter people in crisis, whether in schools—the school resource officers—or in the community at large. So, sharing information can potentially be beneficial, in fostering responses that are oriented to treatment rather than punishment. The sharing of information can be helpful in sort of influencing how officers respond to people. That they view the situation as one requiring crisis intervention, rather than somebody engaging in criminal behavior that needs to be apprehended and punished. And finally, and this really is in the broader treatment context—in the coordination of care, there are, you know the mental health system has historically operated outside the mainstream health care system, so there’s been historically very very poor coordination of care—physical health care with mental health care—and that’s true for young people as well. And the consequences have been nothing short of calmative in terms of premature death, lots of medical problems that could have been addressed if there’d been better coordination, and poorer treatment outcomes overall. So sharing of information can be extremely beneficial, and we really need to work towards a system and a society that is more open to sharing of information.
Vonda
05:39 I agree. Also, the HIPPA and FERPA laws are often blamed for this lack of ability to share important information between schools, mental health, and law enforcement. What kind of information can be shared and where can people learn more so they can help overcome those barriers of sharing information?
Ron
05:54 Well, there’s a lot of grey area when it comes to HIPPA and FERPA, and first let me just distinguish between HIPPA and FERPA. HIPPA is the federal law that applies to health privacy, the privacy of personal health records and information. Whereas FERPA is the federal law that applies to privacy of educational records. I think many of us have been shocked when our kids go off to college, and even when we pay tuition, we don’t necessarily get a copy of their grades. Both of those laws have been historically very very much misunderstood. So, with HIPPA for example, there’s the assumption that if a person doesn’t provide consent, a health provider is absolutely, unequivocally prohibited from sharing information—that’s not true. The HIPPA law actually allows for sharing of information, under a number of circumstances. For example, providers can share information among each other without consent, for purposes of coordination of care. In a law enforcement context, and this is a little bit more complicated, but there are a number of circumstances where health providers are permitted to share information with law enforcement, and one of those—and this is actually quoting directly from the law—“to prevent or lessen a serious and imminent threat to the health and safety of an individual or the public.” Now, what that really means is that a health provider has discretionary authority to share information with a law enforcement officer or law enforcement system, if he or she thinks that it will lessen the potential threat to the health and safety of the individual they’re treating. More often than not, obviously, that information isn’t shared. I can think, however, of some models where there has been effective sharing of information, and one that really pops into my mind is a program, a demonstration project that’s taking place in Georgia right now, called “Opening Doors to Recovery” or ODR, and that program is actually targeted for a hundred people with co-occurring mental illnesses and substance abuse disorders who have historically either been in the hospital for long periods of time or have cycled between hospitals and jails and prisons. People who are frequently referred to as “frequent flyers,” people who historically cost the system the most, people who are most at risk of falling through the cracks. The people who law enforcement most often come into contact with. And these hundred individuals in this ODR program receive very intensive services and supports. And police, the local law enforcement community is part of this process, part of this program. So local CIT officers in that particular region of Georgia, it’s um, the region where, it’s Savannah and Brunswick and that area along the coast. Those CIT officers have access to information. They have a database and basically have access to information that ODR clients are part of that system, and they have information—if they come into contact with an individual who’s an ODR client. Now the key there, is that when people became involved with the ODR program they signed consent forms. But what’s important to recognize is that law enforcement officers are part of the system—they’re seen as key so they know when they encounter someone in crisis they know that they should call the case manager. They know that a therapeutic intervention is the most appropriate course, rather than a punitive intervention. Obviously if they’re dealing with a situation that involves a serious crime, that’s a different story, but more often than not, that’s not what they are dealing with. And I would just extend this to the school context.
Vonda
09:41 Right.
Ron
09:42 School resource officers are really in a position to be part of the system for helping young people in crisis, and schools are really in a position to get consent from family members to sharing information with the school resource officers. Darcy and I have both done lots of work with school resource officers; have met school resource officers around the country, and they’ve told us that they are often—like in the regular community—the front-line responders to young people in crisis. They are in a position to make a difference in how they respond, and they should have basic information that the child, you know, has a mental health disorder. It doesn’t mean that they need to know all of the intimate details. But they shouldn’t have—they should have information that the child has a mental health disorder, they should have information about what to do if the child is in crisis.
Vonda
10:31 Those are good points. You had mentioned that basically law enforcement are the first-line responders unfortunately for many people who are in crisis. You mention CIT, do mind just elaborating on what CIT is? Or if there’s other effective ways that you think law enforcement can better serve those people in a mental health crisis?
Ron
10:49 Well the best model, and the one that NAMI has been most involved with over the years is CIT, which stands for Crisis Intervention Team programs, and those are partnerships between the police and other first responders and the mental health system. And they involve both training police officers about how to respond effectively to people in crisis, and also triage centers that are established so that the police officers can on a timely basis can get the person linked with treatment and go back out on the street and not have to spend hours and hours sitting with the person in an emergency room, or processing them at the local jail. So, in terms some of the more effective ways law enforcement can respond to someone in a mental health crisis, in some ways—and this is what I’ve heard from police officers and those who actually do the training and what I’ve observed in some of the trainings that I’ve attended—some ways the officers have to throw the traditional rules or the traditional ways that they respond to people in the streets—or in the schools—out the window. They have to approach the person in crisis in a more reassuring way. Not argue with the person—particularly if the person is actively psychotic and may be hallucinating. It’s not productive to argue with the hallucinations, so to speak.
Vonda
12:05 Right.
Ron
12:06 Rather to respond in a reassuring way, to—and certainly to avoid surrounding the person, yelling at the person, screaming at the person, because that can be akin to pouring gasoline on the fire and make the crisis worse. Keep a distance. Get through to the person at some basic level that they’re there to help, not to hurt the person. That is SO key, and that can mean, that can make the difference between a tragic outcome and a very positive outcome.
Vonda
12:34 That’s a good point. Thank you Ron. Actually, can we talk to you, Darcy? I have a question. What does NAMI have to offer families in crisis or under stress of having a loved one who may be struggling with a mental illness and where can they find resources?
Darcy
12:47 Thank you for inviting me on. I appreciate this opportunity to talk with this very important audience. We have actually a number of different programs that we can offer to families. As you may know, NAMI has a very strong grassroots organization that consists of 50 state organizations—one in each state—and then we have 1,100 state and affiliated organizations—the affiliates are in communities around the country. So we have a very robust grassroots organization out there to help support families. We also have structured programs that NAMI National has developed, like NAMI Basics, which is designed specifically for families of children and caregivers—rather for parents and caregivers of children with mental illness. And it’s a 6 week course; families come one day a week, and, really it gives them a lot of education information about emerging mental illness and existing mental illness in children and teens, but also allows them to connect to other families, feel less isolated, feel less alone. Many of the organizations that are part of the NAMI broader organization across the country also offer support groups for families. These are really critical key opportunities for families to come together and share tips, ideas, and to really show empathy for each other and to make very clear that they’re not alone. And again, families tend to go, kind of turn inward when a loved one has a mental illness, it’s very hard to accept. There’s a process of acceptance, and these support groups really help families come together—and ultimately get involved in advocacy and change, which is so critically important.
Also, NAMI.org, I would really encourage law enforcement officers and other stakeholders to look at NAMI.org—our website—it has many many resources, there are discussion groups of parents and families talking about tips on things they found that really work. There are discussion groups among other stakeholders. There are fact sheets; information about different medication, side-affects, illnesses, everything you can imagine is really on that site.
Vonda
14:50 That is really good. And are there other opportunities just for maybe online training, or just online information? You mentioned some of the resources that were there.
Darcy
14:58 There are going to be actually. We are doing an entirely new program in the e-learning mode. Those are being developed now, they’re not yet available. That’s a whole new kind of area for NAMI moving into. There is a lot of benefit to families coming together and meeting up in person, so we don’t want to sort of minimize the importance of that, because that is so critically important for families.
But again, there will be e-learning—especially with parents of children that are struggling with mental illness, because those parents often have very little free time, there often other siblings in the home that the families need to be addressing the needs of, so it can be very hard for them to leave the home. They don’t always have a caregiver that understands the needs of the child. So it is helpful to have online programs, and those are something that we’re going to be rolling out in the very near future.
Vonda
15:49 That’s wonderful. And on your website, is that where they would find out information about the support groups, so when they do want to have that face-to-face [Darcy: Yep!] that’s where they find it? Wonderful. So NAMI.org is the place to get all that information.
Darcy
16:02 We actually have maps on there, and so a law enforcement officer—anyone who’s interested in connecting a family with an organization can click on a state and it lists all the affiliates, and it has a lot of important information on there.
Vonda
16:15 That’s terrific. What are some of the costs and benefits of reaching and connecting children and the families sooner with mental health services? Some would say it’s a cost up front—what about the long term?
Darcy
16:27 I mean there’s so many benefits, it’s really hard not to you know, sort of talk about the importance of it. Obviously the cost is the cost of treatment. We actually have research that shows that if you wait and don’t intervene early, there’s a very high probability that the long term disability will become more severe. In another words, there is all kinds of research showing with early on-set schizophrenia, for example, if you can catch the psychosis very early that you will have much better results in the long-term treatment of a person that has, for example, schizophrenia. And so, we can really help lessen the long-term effects of the illness, and the severity of the disability that’s associated with the mental illness if we can catch it early.
Um, also, kids who—the costs are much higher for not catching it early. For example, we know there’s a very high dropout and school failure rate for students that have mental illness—we have the highest dropout and failure rate of any disability group. So when kids aren’t in school, the chances of their doing things that they shouldn’t be, in terms of contact with law enforcement, engaged in sort of anti-social activity in the community, are much higher; getting involved in drugs and alcohol—especially if they have a mental illness, because they tend to use drugs and alcohol to self-medicate. Also, we have very good data and research, very well documented, on the National Center for Mental Health and Juvenile Justice, on their website showing there’s a very high percentage of youth in the juvenile justice system in this country that have one or more psychiatric disorders. In fact, 70 percent, their research shows, have one or more psychiatric disorders, and 20 percent of those youth have serious mental illness. So we know young people are coming into contact with law enforcement, we’re very concerned about that. We don’t think they’re necessarily in the best position to be addressing the needs of students and young people that have very serious mental illness.
Also, youth suicide is a major problem. It’s the third leading cause of death among 15- to 24-year-olds; we lose about 4,400 young people every year to youth suicide. So we really want to be able to address that.
So the costs, really, are minimal in terms of treatment when you look at the costs associated with not providing access to treatment, and not identifying children early, and not identifying teens early—and the benefits are great; you can keep their lives on track, you can keep them in school, you can help create harmony within their family, you can really support families by getting young people into services.
Vonda
19:03 Those are all really good points, hopefully. Is there anything else either one of you’d want to add about recommendations or suggestions you’d like to share with our audience today?
Darcy
19:10 I would just like to say that NAMI really appreciates the commitment of so many law enforcement officers who are CIT-trained, as Ron said, in Crisis Intervention Training, who understand that people with mental illnesses really need to be linked with treatment, and linked with services, and the importance of that. I would also suggest that we have part of our website—if you look at NAMI.org\CITforyouth—we’ve developed a number of resources that are specifically designed for law enforcement officers to receive training to understand how to better address the needs youth who are struggling with mental illness. And especially school resource officers, who really often encounter these young people at a young age, and can be so incredibly helpful. But I also think we need to support schools—that we need better school-based mental health. We need better school-based mental health services. We need to build links between the schools and the community mental health system, and schools can’t do this alone. They need the commitment of organizations like NAMI, law enforcement agencies, community mental health agencies; we all need to come together. That saying “it takes a village” is so true. When it comes to making sure that children that have mental illnesses are linked with the services and supports they really need.
Ron
20:22 I would only add that, um—and I echo Darcy’s appreciation of both, you know, law enforcement agencies and officers around the country, and also your program and the justice department in general, you’ve been wonderful partners over the years. But I would add one additional thing—in recent years we’ve come to realize that the law enforcement community can be wonderful partners of ours in some of our advocacy efforts in states. The fact of the matter is, is that when states decimate funding of mental health services, when they make cuts to Medicaid—people with mental illnesses are among the largest beneficiaries of Medicaid—we all pay a price, and the law enforcement community probably pays the biggest price. So in states like Florida, which has a coalition called Florida Partners in Crisis, the law enforcement community has been front and center in advocacy efforts to go to the legislature and try to help them make sound decisions. We understand that these are economically difficult times, but when we use a meat cleaver to decimate mental health services, in the long run we incur far greater expense, costs as a society, so we hope that these kind of coalitions can continue to develop, and that law enforcement can be key partners of ours in these kind of efforts.
Vonda
21:42 Excellent points. Thank you both for providing your expertise and your time today. And sharing, just your experiences and some resources that might be helpful to our audience. Thank you so much.
Darcy
21:52 Thank you so much for having us!
Beat Exit
Voiceover:
21:54 The Beat was brought to you by the United States Department of Justice COPS Office. The COPS Office helps to keep our nation’s communities safe by giving grants to law enforcement agencies, developing community policing publications, developing partnerships, and solving problems.
Disclaimer:
22:10 The opinions contained herein are those of the authors and do not necessarily represent the official position or polices of the U.S. Department of Justice. References to specific agencies, companies, products, or services should not be considered an endorsement by the authors or the U.S. Department of Justice. Rather, the references are illustrations to supplement discussion of the issues.
####END OF TRANSCRIPT####